Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture

Antonio Russo, Rakesh M. Suri, Francesco Grigioni, Veronique Lee Roger, Jae Kuen Oh, Douglas W. Mahoney, Hartzell V Schaff, Maurice E Sarano

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.

Original languageEnglish (US)
Pages (from-to)1528-1534
Number of pages7
JournalCirculation
Volume118
Issue number15
DOIs
StatePublished - Oct 7 2008

Fingerprint

Papillary Muscles
Mitral Valve Insufficiency
Rupture
Myocardial Infarction
Coronary Artery Bypass
Survival
Mortality
Transplants
Heart Failure
Odds Ratio
Cardiogenic Shock
Pulmonary Edema
Heart Arrest
Survivors
Therapeutics

Keywords

  • Coronary disease
  • Heart failure
  • Mitral valve
  • Myocardial infarction
  • Surgery
  • Survival
  • Valves

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture. / Russo, Antonio; Suri, Rakesh M.; Grigioni, Francesco; Roger, Veronique Lee; Oh, Jae Kuen; Mahoney, Douglas W.; Schaff, Hartzell V; Sarano, Maurice E.

In: Circulation, Vol. 118, No. 15, 07.10.2008, p. 1528-1534.

Research output: Contribution to journalArticle

Russo, Antonio ; Suri, Rakesh M. ; Grigioni, Francesco ; Roger, Veronique Lee ; Oh, Jae Kuen ; Mahoney, Douglas W. ; Schaff, Hartzell V ; Sarano, Maurice E. / Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture. In: Circulation. 2008 ; Vol. 118, No. 15. pp. 1528-1534.
@article{0ac31518549341b8bad2e7ac59e172db,
title = "Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture",
abstract = "Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74{\%} male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91{\%} preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95{\%} CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95{\%} CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5{\%}) decreased from 67{\%} up to 1990 without coronary artery bypass graft to 8.7{\%} after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7{\%}, and survival free of congestive heart failure was 52±7{\%}. Five-year survival of 30-day operative survivors was 79±4{\%}, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8{\%} versus 36±6{\%}; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.",
keywords = "Coronary disease, Heart failure, Mitral valve, Myocardial infarction, Surgery, Survival, Valves",
author = "Antonio Russo and Suri, {Rakesh M.} and Francesco Grigioni and Roger, {Veronique Lee} and Oh, {Jae Kuen} and Mahoney, {Douglas W.} and Schaff, {Hartzell V} and Sarano, {Maurice E}",
year = "2008",
month = "10",
day = "7",
doi = "10.1161/CIRCULATIONAHA.107.747949",
language = "English (US)",
volume = "118",
pages = "1528--1534",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "15",

}

TY - JOUR

T1 - Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture

AU - Russo, Antonio

AU - Suri, Rakesh M.

AU - Grigioni, Francesco

AU - Roger, Veronique Lee

AU - Oh, Jae Kuen

AU - Mahoney, Douglas W.

AU - Schaff, Hartzell V

AU - Sarano, Maurice E

PY - 2008/10/7

Y1 - 2008/10/7

N2 - Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.

AB - Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.

KW - Coronary disease

KW - Heart failure

KW - Mitral valve

KW - Myocardial infarction

KW - Surgery

KW - Survival

KW - Valves

UR - http://www.scopus.com/inward/record.url?scp=55249108200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55249108200&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.107.747949

DO - 10.1161/CIRCULATIONAHA.107.747949

M3 - Article

C2 - 18809799

AN - SCOPUS:55249108200

VL - 118

SP - 1528

EP - 1534

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 15

ER -